Surgical tool

ABSTRACT

A surgical tool for minimally invasive surgery. The surgical tool in one embodiment includes a manipulator as a user interface, a proximal universal joint mounted to the manipulator, a hollow elongated member such as a tube mounted to the proximal universal joint, and a distal universal joint mounted to the other end of the elongated member. An end effector is mounted to the distal universal joint second end. Pivoting of the first end of the proximal universal joint causes the second end of the distal universal joint to move in a corresponding motion, and cabling operatively couples the proximal and distal universal joints. The proximal and distal universal joints may each include two yokes and a center block. Cabling may include four cables that each engage two round elements at the proximal and distal universal joints mounting locations to the center block.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/014,248, filed Jan. 26, 2011, which claims the benefit of U.S.Provisional Application No. 61/418,928, filed Dec. 2, 2010, entitled“SURGICAL TOOL,” the contents of both of which are hereby incorporatedby reference in their entirety.

BACKGROUND

Embodiments described herein generally relate to surgical apparatus fortissue and suture manipulation, and more particularly to apparatus thatmay be applied to conducting laparoscopic and endoscopic surgery.

Minimally invasive surgery, such as endoscopic surgery, encompasses aset of techniques and tools which are becoming more and more commonplacein the modern operating room. Minimally invasive surgery causes lesstrauma to the patient when compared to the equivalent invasiveprocedure. Hospitalization time, scarring, and pain are also decreased,while recovery rate is increased.

Endoscopic surgery is accomplished by the insertion of a cannulacontaining a trocar to allow passage of endoscopic tools. Optics forimaging the interior of the patient, as well as fiber optics forillumination and an array of grasping and cutting devices are insertedthrough a multiple cannulae, each with its own port.

Currently the majority of cutting and grasping tools are essentially thesame in their basic structure. Standard devices consist of a userinterface at the proximal end and an end effector at the distal end ofthe tool used to manipulate tissue and sutures. Connecting these twoends is a tube section, containing cables and/or rods used fortransmitting motion from the user interface at the proximal end of thetool to the end effector at the distal end of the tool. The standardminimally invasive devices (MIDs) provide limited freedom of movement tothe surgeon. The cannula has some flexibility of movement at the tissuewall, and the tool can rotate within the cannula, but tools cannotarticulate within the patient's body, limiting their ability to reacharound or behind organs or other large objects. Several manuallyoperated devices have attempted to solve this problem with articulatedsurgical tools that are controlled much in the same way as standardMIDs. These devices have convoluted interfaces, making them moredifficult to control than their robotic counterparts. Many lacktorsional rigidity, limiting their ability to manipulate sutures anddenser tissue.

Robotic surgical instruments have attempted to solve the problems thatarise from the limitations of standard MIDs with telemetricallycontrolled articulated surgical tools. However, these tools are oftenprohibitively expensive to purchase and operate. The complexity of thedevices raises the cost of purchasing as well as the cost of a servicecontract. These robotic solutions also have several other disadvantagessuch as complications during the suturing process. An additional andcritical disadvantage is their lack of haptic feedback.

Due to variations in tissue density and structure, a surgeon will usemany tools with differently shaped end effectors to manipulate tissue.This requires the surgeon to remove tools from their cannulae andreplace them with different tools many times through the course of aprocedure. Currently available MIDs do not provide the same versatilityin tissue manipulation as is available in open surgery.

SUMMARY

In accordance with one embodiment, a surgical tool is provided for useby an operator. The surgical tool includes a manipulator adapted toreceive at least a portion of the operator's hand. A proximal universaljoint with a first end and a second end has its first end mounted to themanipulator, and a hollow elongated member has a first end that ismounted to the proximal universal joint second end, a second end, and alongitudinal axis. A distal universal joint has a first end that ismounted to the elongated member second end, and a second end. An endeffector is mounted to the distal universal joint second end. In oneembodiment, pivoting of the first end of the proximal universal jointcauses the second end of the distal universal joint to move in acorresponding motion, and cabling operatively couples the proximal anddistal universal joints.

In accordance with another embodiment, the proximal and distal universaljoints each include a proximal yoke at the first end, a distal yoke atthe second end, a center block, and means for pivoting the center memberabout two perpendicular, coplanar axes through the center block. Theproximal yoke is mounted to the center block at first and secondmounting locations, the distal yoke is mounted to the center block atthird and fourth mounting locations, and between the center block andeach yoke at each mounting location are round elements, which may beindependent parts or integral to either of the center block or yokes.The cabling comprises four cables that each engage two of the roundelements at each of the proximal and distal universal joints. Pivotingthe proximal yoke on the proximal universal joint causes a correspondingmotion of the distal yoke of the distal universal joint.

In accordance with another embodiment, an articulation system for asurgical tool is provided. The system includes a proximal universaljoint including a proximal end member and a distal end member, a hollowelongated member having a first end, a second end, and a longitudinalaxis, with the elongated member first end being mounted to the proximaluniversal joint distal end member, and a distal universal jointincluding a proximal end member and a distal end member, with the distaluniversal joint proximal end member being mounted to the elongatedmember second end. Universal joint control cables operatively connectthe proximal and distal universal joints. Pivoting motion of theproximal end member of the proximal universal joint relative to thelongitudinal axis of the elongated member exerts force on cables tocause a corresponding pivoting motion of the distal end member of thedistal universal joint.

In accordance with another embodiment, a surgical tool for use by anoperator is provided. The surgical tool includes a manipulator adaptedto receive at least a portion of the operator's hand. The manipulatorincludes a mounting end, a first actuator, and a second actuator. Ahollow elongated member has a first end, a second end, and alongitudinal axis, with the first end operatively connected to themounting end of the manipulator. An end effector includes a mounting endthat is operatively connected to the elongated member second end, andthe end effector includes a base member and two opposed digits. Eachdigit includes a proximal phalange having a first end and a second end,with the first end pivotally mounted to the base member, and a distalphalange having a first end and a second, free end, with the first endpivotally mounted to the proximal phalange second end. The firstactuator is operable to concurrently control the proximal phalanxes andthe second actuator is operable to concurrently control the distalphalanxes.

In accordance with another embodiment, a method of operating a surgicaltool is provided. The method includes pivoting the manipulator relativeto the longitudinal axis of the elongated member to pivot the first endof the proximal universal joint, and pulling at least two cables withthe pivoting of the proximal universal joint to cause the second end ofthe distal universal joint to pivot.

Further features of a surgical tool will become more readily apparentfrom the following detailed description taken in conjunction withaccompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

For a more complete understanding, reference should now be had to theembodiments shown in the accompanying drawings and described below. Inthe drawings:

FIG. 1 is a perspective view of an embodiment of a surgical tooldescribed herein.

FIG. 2 is a perspective view of the surgical tool shown in FIG. 1 in analternate position.

FIG. 3 is a left side view of the surgical tool shown in FIG. 1.

FIG. 4 is a top view of the surgical tool shown in FIG. 1.

FIG. 5 is a right side view of the surgical tool shown in FIG. 1.

FIGS. 6 and 7 are left perspective views of a manipulator end portionand an end effector end portion, respectively, of the surgical toolshown in FIG. 1, in a corresponding first position.

FIGS. 8 and 9 are left perspective views of the manipulator end portionand the end effector end portion, respectively, of the surgical toolshown in FIG. 1, in a corresponding second position.

FIGS. 10 and 11 are left perspective views of the manipulator endportion and the end effector end portion, respectively, of the surgicaltool shown in FIG. 1, in a corresponding third position.

FIGS. 12 and 13 are left perspective views of the manipulator endportion and the end effector end portion, respectively, of the surgicaltool shown in FIG. 1, in a corresponding fourth position.

FIGS. 14 and 15 are exploded perspective views of the end effector endportion of the surgical tool shown in FIG. 1.

FIG. 16 is a perspective view of an articulation system of the surgicaltool shown in FIG. 1, including embodiments of proximal and distaluniversal joints.

FIG. 17 is a cross section view of the distal universal joint assemblyshown in FIG. 16.

FIG. 18 is a partial section view of the distal joint assembly shown inFIG. 16, with a 90 degree wedge removed.

FIG. 19 is a partial section view of the distal universal joint assemblytaken along the same lines as the section of FIG. 18, rotated forviewing another face of the section view.

FIG. 20 is a perspective view of the distal universal joint assemblyshown in FIG. 16 with a portion of a yoke removed.

FIG. 21 is a section view of the distal universal joint assembly shownin FIG. 16, taken along two faces of the distal universal jointassembly.

FIG. 22 is a partially exploded left perspective view of the endeffector portion of the surgical tool shown in FIG. 1.

FIG. 23 is a left perspective view of the end effector shown in FIG. 14.

FIG. 24 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken from the view of FIG. 23.

FIG. 25 is a right perspective view of the end effector shown in FIG.14.

FIG. 26 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken from the view of FIG. 25.

FIG. 27 is a left perspective view of the end effector shown in FIG. 14,with the end effector in a first position.

FIG. 28 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken offset from center and in the same position asin the view of FIG. 27.

FIG. 29 is a left perspective view of the end effector shown in FIG. 14,with the end effector in a second position.

FIG. 30 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken offset from center and in the same position asin the view of FIG. 29.

FIG. 31 is a left perspective view of the end effector shown in FIG. 14,with the end effector in a third position.

FIG. 32 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken offset from center and in the same position asin the view of FIG. 31.

FIG. 33 is a left perspective view of the end effector shown in FIG. 14,with the end effector in a fourth position.

FIG. 34 is longitudinal section perspective view of the end effectorshown in FIG. 14, taken offset from center and in the same position asin the view of FIG. 33.

FIG. 35 is a left perspective view of an embodiment of a manipulator asshown in FIG. 1.

FIG. 36 is a back elevation view of the manipulator shown in FIG. 35.

FIG. 37 is a right perspective view of the manipulator shown in FIG. 35.

FIG. 38 is a front right perspective view of the manipulator shown inFIG. 35.

FIG. 39 is an exposed left perspective view of the manipulator shown inFIG. 35.

FIG. 40 is a top perspective partially exploded view of the manipulatorshown in FIG. 35.

FIG. 41 is a top left perspective partially exploded view of themanipulator shown in FIG. 35.

FIGS. 42-45 are perspective detail views of a universal joint tensioningassembly of the manipulator shown in FIG. 35.

FIGS. 46-48 are perspective detail views of an active tensioningassembly for end effector control cables at the manipulator shown inFIG. 35.

FIGS. 49 and 50 are perspective detail views of end effector cablemuting at the manipulator shown in FIG. 35.

DETAILED DESCRIPTION

Embodiments of a surgical instrument are disclosed for use in a widevariety of roles including, for example, grasping, dissecting, clamping,electrocauterizing, or retracting materials or tissue during surgicalprocedures performed within a patient's body.

Certain terminology is used herein for convenience only and is not to betaken as a limitation. For example, words such as “upper,” “lower,”“left.” “right,” “horizontal,” “vertical,” “upward,” and “downward”merely describe the configuration shown in the figures. The componentsmay be oriented in any direction and the terminology, therefore, shouldbe understood as encompassing such variations unless specifiedotherwise.

Referring now to the drawings, wherein like reference numerals designatecorresponding or similar elements throughout the several views, anembodiment of a surgical tool is shown in FIGS. 1-5 and is generallydesignated at 100. The surgical tool 100 includes embodiments of fiveprimary components: a manipulator 102, a proximal universal joint 104,an elongated, hollow member or tube 106, a distal universal joint 108,and an end effector 110. The manipulator 102 attaches to the surgeon'shand, with fasteners such as hook and loop fastener straps (not shown)around the index finger and the thumb. The manipulator 102 and the endeffector 110 and connected with cables, as discussed further below, suchthat when the surgeon moves his finger and thumb to control themanipulator 102, the end effector 110 has corresponding movements. Thesurgical tool 100 is shown in use in FIGS. 1 and 2, with a portion ofthe tube 106, the distal universal joint, and end effector 110 havingpassed through a tissue wall 112 via a cannula 114.

The movement of the proximal universal joint 104, which is attached tothe manipulator 102, controls the movement of the distal universal joint108. The universal joints 104, 108 are connected to each other withcables, as will be discussed further below, and each of the universaljoints 104, 108 provide two degrees of freedom, being free to move inany combination of directions deflecting from the longitudinal axis ofthe tube 106. The cabling arrangement enables a surgeon to angle themanipulator 102 with his or her hand relative to the proximal universaljoint 104 to cause the distal universal joint 108 to move in a similarmanner in the opposite direction, imitating the surgeon's movements andproviding directional control of the distal portion of the device. Suchcorresponding pivoted positions of the manipulator 102 and the endeffector 110 relative to the longitudinal axis of the tube 106 are shownin FIGS. 2, 4, and 5. The maximum angle of deflection θ in everydirection from the longitudinal axis of the tube 106 shows the range ofmotion at each end of the tool 100, and is determined by the design ofthe universal joints 104, 108 and the direction of deflection, and mayvary from that shown. The tube 106 contains the cabling that connectsthe manipulator 102 to the end effector 110 and the proximal universaljoint 104 to the distal universal joint 108.

FIGS. 6 through 13 depict the correlation between positions of themanipulator 102 and end effector 110. The manipulator 102 includes inthe embodiment shown a base assembly 140, a thumb assembly 142, aprimary index assembly 144, and a secondary index assembly 146. Themanipulator 102 is shown in a right handed configuration, but theposition of parts may be reversed to be for left handed use as well. Theend effector 110 includes in the embodiment shown two digits 150, 152,each of which includes a proximal phalange 154, 156 and a distalphalange 158, 160 mounted to the respective proximal phalanxes 154, 156.The proximal phalanxes 154, 156 are mounted to a base member 162, whichis mounted to the distal universal joint 108. The thumb assembly 142,primary index assembly 144, and secondary index assembly may beconsidered in this embodiment to be assemblies that are functionallylevers, but the assemblies 142, 144, 146 may take other forms indifferent embodiments. The motion of the thumb assembly 142, which isfollowed by the primary index assembly 144, controls the motion of theboth proximal phalanxes 154, 156 in the end effector 110. The motion ofthe secondary index assembly 146 controls the motion of both distalphalanxes 158, 160 in the end effector 110.

The end effector 110 may be designed to grasp, manipulate, and dissecttissue planes of varying densities and structures. The two digits 150,152 of the embodiment of the end effector 110 of FIG. 7 move in amirrored motion, such that the digits 150, 152 are symmetrical inangular position. The ability of the distal phalanxes 158, 160 of eachdigit 150, 152 to deflect inward while the proximal phalanxes 154, 156of each digit 150, 152 are open allows the end effector 110 to pinchtissue, which may apply more pressure than in a standard tissuemanipulating tool. Since the angle of deflection of the distal phalanxes158, 160 is variable, the amount of potential pressure applied to tissuecan be varied during operation depending on the density and structure ofthe tissue being manipulated. Additionally, the deflection of the distalphalanxes 158, 160 may permit the grasping and retraction of largersections of tissue and organs than may be permitted by current tools.Alternatively, in some uses, for example, grasping sutures, it may bedesirable to have an end effector that omits distal phalanxes, andaccordingly would require a simpler manipulator. The surgical tooldescribed herein may be adapted to accommodate a variety of types anddesigns of end effectors.

The user's hand is releasably attached to the manipulator 102 such thatthe tip of the index finger aligns with the adjustable finger grip 164that is slidably mounted in a slot 166 in the secondary index assembly146, and the tip of the thumb aligns with the adjustable thumb grip 168on the thumb assembly 142. The index finger also attaches to a fingergrip 170 on the primary index assembly 144 (portions of the grips 164,170 where contact is made with the finger are not visible). Theseattachment points provide an interface for control of the manipulator102 and corresponding actuation of the end effector 110.

FIG. 6 shows the manipulator 102 in a position corresponding to thefully open position of the end effector 110 in FIG. 7. In FIG. 6, theprimary index assembly 144 and thumb assembly 142 are deflected outwardat the limit of their ranges of motion, and accordingly so are theproximal phalanxes 154, 156 in the end effector 110 in FIG. 7. Alsoshown in its fully outward deflected position, the secondary indexassembly 146 of the manipulator 102 is only slightly offset from theangular position of the primary index assembly 144. In FIG. 7 and in thecorresponding position, the distal phalanxes 158, 160 are substantiallyin alignment with the proximal phalanxes 154, 156. This positioningdefines the fully open position.

FIG. 8 shows the manipulator 102 in a position corresponding to the opengripping position of the end effector 110 in FIG. 9. In FIG. 8, theprimary index assembly 144 and thumb assembly 142 are deflected outwardat the limit of their ranges of motion as in FIG. 6, and accordingly soare the proximal phalanxes 154, 156 in the end effector 110 in FIG. 9.The secondary index assembly 146 of the manipulator 102 is deflectedinward at the limit of its range of motion, and the distal phalanxes158, 160 in the end effector 110 are in their corresponding inwardposition in FIG. 9.

FIG. 10 shows the manipulator 102 in a position corresponding to theclosed pinching position of the end effector 110 in FIG. 11. In FIG. 10,the secondary index assembly 146 is in the same angular positionrelative to the primary index assembly 144 as in FIG. 8, resulting indistal phalanxes 158, 160 being in the same position relative to theproximal phalanxes 154, 156 as in FIG. 9. In FIG. 10, the primary indexassembly 144 and thumb assembly 142 are deflected inward by an angularmovement corresponding to the positioning of the proximal phalanxes 154,156, which brings the tips of the distal phalanxes 158, 160 together ina pinching motion.

FIG. 12 shows the manipulator 102 in a position corresponding to thefully closed position of the end effector 110 in FIG. 13. In FIG. 12,the secondary index assembly 146 is deflected outward at the limit ofits range of motion, as are the corresponding distal phalanxes 158, 160of the end effector 110 in FIG. 13. In FIG. 12, the primary indexassembly 144 and thumb assembly 142 are deflected inward to the limit oftheir ranges of motion, and accordingly so are the proximal phalanxes154, 154 in the end effector 110 in FIG. 13.

FIGS. 14 and 15 show the distal end of the embodiment of the surgicaltool 100, where the distal universal joint 108 is mounted to the tube108, and the end effector 110 is mounted to the distal universal joint108. As shown in FIG. 15, in this embodiment the distal universal joint108 includes a proximal yoke 200 and a distal yoke 202 in aperpendicular orientation. The yokes 200, 202 each include a baseportion with two opposing arms extending substantially perpendicular tothe base from the perimeter of the base. The yokes 200, 202 are mountedto a center block 204 with the ends of two perpendicular, coplanar pins206, 208 disposed in holes 210, 212 in the yokes 200, 202. The centerblock 204 may be any shape that permits mounting of the yokes 200, 202and concurrent pivoting about two axes. Pins 206, 208 may each includeone or two pins or protrusions extending from the center block 204 asshown, or may be pins or protrusions formed in the arms of the yokes200, 202 and extending into openings in the center block 204. For easeof manufacturing and assembly, each yoke 200, 202 may be made up of twohalves 214, 216, 218, 220 as shown, or may be made of single pieces.Four holes 222 arranged about the center of the yokes 200, 202 and onelarger hole 224 through the center of the center block 204 are providedto pass four cables (not shown) to control the end effector 110 from themanipulator 102, and two oblong shaped holes 226 are provided in theproximal and distal yokes 200, 202 to pass the cables for the universaljoints 104, 108. In the embodiment of a surgical tool 100 shown, theproximal universal joint 104 is the same design as the distal universaljoint 108, and as shown in FIG. 16 includes a proximal yoke 230, distalyoke 232, and center block 234.

FIG. 16 further depicts the means by which the proximal universal joint104 controls the distal universal joint 108. Four cables 240 a, 240 b,240 c, 240 d connect the two joints 104, 108, are fixed at both ends,and control the motion of the universal joints 104, 108 about their twoprimary axes, as established, for example, by the pins 206, 208 (FIG.15) in the distal universal joint 108. At the distal end of the moredistal yoke 200, this can be accomplished at the distal universal joint108 with means including, but not limited to, adhesive, swagedcomponents, or other friction fit-based mechanism. Cables 240 a and 240c may each may be one cable that doubles back distal of the distal yoke200, as may cables 240 b and 240 d, or they may be separate cables asshown. Regardless of whether they are separate or a single cable, thecables are all in a fixed position at the distal point of the distalyoke 200. With respect to the proximal universal joint 104, the ends ofthe cables 240 a, 240 b, 240 c, 240 d are fixed via a set of tensioningassemblies in the manipulator 102, discussed further below. This allowsthe relative positioning of the proximal and distal universal joints104, 108 to be calibrated during manufacturing.

Exemplary operational scenarios are as follows. When the distal yoke 232of the proximal universal joint 104 pivots 242 about the proximal centerblock 234 in a clockwise direction (designated CD), then cables 240 cand 240 d are displaced downward and cables 240 a and 240 b aredisplaced upward. This produces a similar pivot 244 in the clockwisedirection CD of the distal yoke 200 of the distal universal joint 108about the distal center block 204. With respect to rotation in aperpendicular plane to motion 242, when the distal yoke 232 of theproximal universal joint 104 causes the proximal center block 234 torotate 246 relative to the proximal yoke 230 in a clockwise direction(designated BD), cables 240 b and 240 d are displaced downward andcables 240 a and 240 c are displaced upward. This produces a similarpivot 248 in the clockwise direction BD of the distal center block 204relative to the proximal yoke 202.

Motion 246 in counterclockwise direction AC in the proximal universaljoint 104 likewise causes motion 248 in counterclockwise direction AC inthe distal universal joint 108, and motion 242 in counterclockwisedirection AB in the proximal universal joint 104 causes motion 244 incounterclockwise direction AB in the distal universal joint 108. Thevarious motions may be combined. The mounting of the proximal yoke 230of the proximal universal joint 104 to the distal end of the manipulator102 results in the movement of the manipulator 102 causing the movementof that yoke 230. All motions of the proximal yoke 230 of the proximaluniversal joint 104 actuate cables 240 a, 240 b, 240 c, 240 d to producesimilar motion in the opposite direction in the distal yoke 200 of thedistal universal joint 108.

FIGS. 17-21 depict a universal joint with the cabling system that drivesboth the proximal and distal universal joints 104, 108. Although it isthe distal universal joint 108 that is shown, this could be the proximaluniversal joint 104, and the proximal and distal universal joints 104,108 generally mirror each other in their configuration about a planeperpendicular to the cabling and between the joints 104, 108.

When the universal joint 108 is assembled, there are round members oneach side of the center block 204 in a parallel plane to the adjacentcenter block sides. The four round members 260, 262, 264, 266 (FIG. 15),which may be part of the center block 204, part of the yokes 200, 202,or independent parts, are used to route the cables 240 a, 240 b, 240 c,240 d to impart force on the joint 108 when the cables are displaced. InFIG. 20, one yoke half 214 is removed to show the cabling system, andall four cables 240 a, 240 b, 240 c, 240 d may be seen at least in partinside the joint 108 in FIG. 21. Pins 270 and holes to receive the pins272 may be used to hold the yoke halves 214, 216, 218, 220 together.Cable 240 b passes through the proximal yoke 200 and around the bottomof a first round member 260, over the top of a second round member 262and into the distal yoke 202. Cable 240 a opposes cable 240 b incontrolling the rotation of the center block 204 about the axis of thefirst round member 260, coincident with pins 206 (and motion 248 of FIG.16). Cables 240 c and 240 d behave similarly with respect to thismovement. Cable 240 b opposes cable 240 d in controlling the rotation ofthe distal yoke 202 about the axis of the second round member 262,coincident with pins 208 (and motion 244 of FIG. 16). Cables 240 a and240 c behave similarly with respect to this movement.

FIGS. 22-26 show an embodiment of an end effector 110. This end effectorincludes the proximal phalanxes 154, 156 mounted to the base member 162with pins 300, 302. Pulleys 304, 306 are mounted with a pin 308 near theproximal end within the base member 162. Each digit 150, 152 contains acontrolling link 310, 312 which is connected to a connecting link 314,316 with pins 318, 320, and the connecting links 314, 316 are connectedto the distal phalanxes 158, 160 with pins 322, 324. The distalphalanxes 158, 160 are also mounted to the proximal phalanxes 154, 156with pins 326, 328.

FIG. 24 illustrates the cabling system and structure controlling themotion of the proximal phalange 154, 156 of each digit 150, 152, wherecable 360 b controls closing and cable 360 d controls opening. Thepulley 304 guides cable 360 d to maintain it with the other end effectorcontrol cables 360 a, 360 b, 360 c in the center of the base member 162.Cables 360 b and 360 d are different ends of the same physical cable inthe preferred embodiment, but may be separate cables in anotherembodiment and are functionally distinct. Cable 360 b passes around apulley section 362 built into the proximal phalange 154 of the firstdigit 150 and enters a hole 364 that secures cable 360 b to the proximalphalange 154 of the first digit 150. Cable 360 b continues back througha second hole 366 in the proximal phalange 154 of the first digit 150,around the pulley section 362 in this phalange 154, and subsequentlyenters a hole 368 that secures it to the proximal phalange 156 of thesecond digit 152. The section of cables 360 b and 360 d between thepoints of fixation 364, 368, which joins the proximal phalanxes 154, 156will be denoted cable 360 e. Cable 360 e couples the motion of theproximal phalanxes 154, 156 such that their motion mirrors each other.The cable 360 d, with the designation starting at hole 368, returnsthrough a second hole 370 in the proximal phalange 156 of the seconddigit 152, passes around a pulley section 372 of that phalange 156,around the guide pulley 304, and exits through the base 162.

The attachment points where the length of cable 360 e is secured to thephalanxes 154, 156 may be created by a combination of friction due tothe cable turning tightly at the entry and exit points of these holes364, 368, as well as adhesive that may be used to secure the cable 360c. The connection may also be created by other means, for example,through friction via a swaging of the first phalanxes 154, 156 at cableentry and exit points, or through an additional component that appliespressure to the cable, creating friction between the cable and thephalanxes 154, 156.

When cable 360 b is pulled towards the manipulator 102, this exerts atorque on the proximal phalange 154 of the first digit 150 in acounterclockwise direction. This in turn exerts a force on cable 360 e,which exerts a clockwise torque on the proximal phalange 156 of thesecond digit 152. The effect of these torques is to bring the proximalphalanxes 154, 156 together. When cable 360 d is pulled, this exerts atorque on the proximal phalange 156 of the second digit 152 in acounterclockwise direction. This in turn exerts a force on cable 360 e,which exerts a clockwise torque on the proximal phalange 154 of thefirst digit 150. The effect of these torques is to separate the proximalphalanxes 154, 156, pulling the digits open. In this manner, cables 360b and 360 d control the opening and closing motion of this embodiment ofthe end effector 110.

FIG. 26 shows the cabling system that controls the four bar mechanismswithin each digit 150, 152 of the end effector 110. Each digit 150, 152includes a controlling link 310, 312 that moves a connecting link 314,316 to actuate the distal phalanxes 158, 160 of the fingers in the endeffector 110. The cabling system that drives the controlling links 310,312 includes cables 360 a and 360 c. Cable 360 a passes around thepulley section 380 in the first controlling link 310 in the proximaldigit 150 of the end effector 110 and into a hole 382 where it issecured to the first controlling link 310. The cable 360 a thencontinues around the pulley section of the first controlling link 310,departing the first controlling link 310 and connecting to the secondcontrolling link 312, passing through a hole 384 that secures it to thesecond controlling link 312. The section of cable between holes 382 and384 will be referred to as cable 360 f. From hole 384, the cable 360 ccontinues around the pulley section 386 of the second controlling link312, goes around the guide pulley 306 and exits through the base member162. The attachment between cable 360 a, 360 c, and 360 f and thecontrolling links 310, 312 may be achieved through any of the methodspreviously described for the proximal phalanxes 154, 156.

When cable 360 a is pulled, it exerts a torque on the first controllinglink 310 in the clockwise direction. This exerts a force on cable 360 f,which in turn exerts a counterclockwise torque on the second controllinglink 312. This causes both controlling links 310, 312 to move inward.When cable 360 c is pulled, it exerts a torque on the second controllinglink 312 in the clockwise direction. This exerts a force on cable 360 f,which in turn exerts a counterclockwise torque on the first controllinglink 310. This causes both controlling links 310, 312 to move outward.

FIGS. 27-34 show the end effector 110 in several positions. FIGS. 27 and28 show the end effector 110 in its closed position. With respect to thefirst digit 150, the controlling link 310 pivots on a pin 300 to actuatethe associated connecting link 314 via pin 318. The connecting link 314in the first digit 150 controls the associated distal phalange 158 via apin 322. The distal phalange 158 pivots relative to the proximalphalange 154 via a pin 326. Similarly, with respect to the second digit152, the controlling link 312 pivots on a pin 302 to actuate theconnecting link 316. The controlling link 312 controls the connectinglink 316 via a pin 320. The connecting link 316 in the second digit 152controls the distal phalange 160 via a pin 324. The distal phalange 160pivots relative to the proximal phalange 156 via a pin 328. The guidepulleys 304, 306 pivot about a pin 308.

The end effector 110 is shown in the fully open position in FIGS. 29 and30. In order to obtain this position, the controlling links 310, 312move outward with their respective proximal phalanxes 154, 156. Thisproduces no movement of the distal phalanxes 158, 160 relative to theproximal phalanxes 154, 156 of each digit 150, 152.

FIGS. 31 and 32 show the end effector 110 in its open gripping position.This can be utilized for grasping or retracting larger tissue structuresor organs. In order to obtain this position, the controlling links 310,312 move outward beyond their respective proximal phalanxes 154, 156 toproduce motion of the connecting links 314, 316, subsequently causingthe distal phalanxes 158, 160 to deflect inward. The motion of thecontrolling links 310, 312 relative to the proximal phalanxes 154, 156thus controls the motion of the distal phalanxes 158, 160 relative tothe proximal phalanxes 154, 156 of each digit 150, 152.

FIGS. 33 and 34 show the end effector 110 in its pinching position. Thiscan be utilized to exert higher gripping pressure on denser tissuestructures for grasping or retraction. In order to obtain this position,the controlling links 310, 312 are deflected outward relative to theirrespective proximal phalanxes 154, 156 as in the open gripping position,but the proximal phalanxes 154, 156 are not outwardly deflected to theextent that they are in the open gripping position.

FIGS. 35-41 show the manipulator 102 in various views. The handlebar 400may be gripped by the third, fourth, and fifth fingers of the user,providing stable control and allowing the user to apply torsion to themanipulator 102. The handlebar 400 attaches to the base assembly 140 atthe handlebar mount 402. FIG. 35 also shows the alternate handlebarmount 404. The manipulator 102 in FIGS. 35-41 is in a right-handedconfiguration. If the handlebar 400 were attached to the alternatehandlebar mount 404, it would be in a left-handed configuration. Allother points at which the user's hand attaches to the manipulator 102can be changed to a left-handed configuration via rotation or sliding.

FIG. 39 shows the manipulator 102 with the alternate handlebar mount 404and one base plate 406 of the two base plates 406, 408 removed. Thecabling system for controlling the end effector 110 and the tensioningassemblies 410, 412 for calibrating the relative position of theproximal and distal universal joints 104, 108 can be seen in thisfigure, as well as the method by which the thumb assembly 142, primaryindex assembly 144, and secondary index assembly 146 control the endeffector 110. The end effector control cables 360 a, 360 b, 360 c, 360 d(cables not labeled in FIG. 39) enter the manipulator 102 through theuniversal joint interface 414 and continue to the active tensioningassemblies 420, 422 which are tensioned by a spring 424 mounted on aspacer 426. The end effector control cables 360 a, 360 b, 360 c, 360 dthen pass around the guide pulley set 428.

The cables 360 b, 360 d that control the motion of the proximalphalanxes 154, 156 of the end effector 110 are then anchored to thethumb assembly 142 that pivots about a pin 430 attached to the baseassembly 140 with bearings. This anchoring is achieved by means of atension adjusting system 432 used in several locations that includesvented screws 434, nuts 436, and swaged tubing 438, as identified withthe ends of cables 360 c and 360 d in FIG. 35. The swaged tubing 438 iscompressed onto the control cables to act as mechanical retentionagainst the head of the vented screws 434. Tension is applied to thecontrol cables by rotating the nut 436 while keeping the correspondingvented screw 434 in a constant rotational position. This produces lineartranslation of the vented screw 434 and a corresponding change intension in its control cable.

The cables 360 a, 360 c that control the motion of the distal phalanxes158, 160 pass around an idling pulley set mounted on a set of shaftadapters 440 and continue to the secondary index assembly 146. Thesecables 360 a, 360 c are connected to the secondary index assembly 146 bymeans of the tension adjusting system 432 similar to that used forcables 360 b and 360 d.

The primary index assembly 144 and thumb assembly 142 are mechanicallycoupled by means of a set of gears 450, 452. This allows the thumb andindex finger of the user to collectively drive the proximal phalanxes154, 156. The thumb assembly 142 adjusts to different hand sizes. Thisis accomplished by a set of moving elements; the thumb slide 454 whichtranslates and rotates within the thumb base 456, and the thumb mount168 which rotates within the thumb slide 454. The linear translation ofthe thumb slide 454 compensates for thumbs of different lengths. Therotation of the thumb slide 454 and thumb mount 168 allows themanipulator 102 to change into a left-handed configuration from theright-handed configuration depicted in FIG. 35-41.

The primary index assembly 144 pivots about the set of shaft adapters440 via a set of bearings in the base plates 406, 408. The primary indexassembly 144 includes two base plates 460, 462 one of which 462 isremoved in FIG. 39. These plates 460, 462 are connected by spacers 464.The primary index mount 170 may attach to the user's index finger (theportion of primary index mount 170 to which a user's finger is attachedis not visible in FIG. 39). The primary index mount 170 can translatelaterally through the primary index assembly 144 to change themanipulator 102 from the right-handed configuration depicted in FIGS.35-41 to a left-handed configuration.

The secondary index assembly 146 pivots about a shaft 466 via a set ofbearings in the primary index base plates 460, 462. The secondary indexbase 468 contains the index slide 470 that can translate and rotatewithin the secondary index base 468. The index slide 470 contains theindex mount 164 that is the attachment point for the tip of the user'sindex finger and can translate laterally through the index slide 470 tochange the manipulator 102 from the right-handed configuration depictedin FIGS. 35-41 to a left-handed configuration. The index slide 470translates along the secondary index base 468 in the slot 166 to adjustto different length index fingers.

In FIGS. 40 and 41 a two-piece guard 472 is shown mounted to the tube106. The guard 472 extends around the proximal universal joint 104. Theguard 472 may be designed to limit the range of motion of themanipulator 102 and proximal universal joint 104 so that neither theproximal or distal universal joints 104, 108 can be driven beyond theiroperating range by the user.

FIGS. 42-45 show detail views of the universal joint static tensionassemblies 410, 412. The universal joint control cables 240 a, 240 b,240 c, 240 d tensioned by these assemblies 410, 412 pass around idlingpulleys 500, 502, 504, 506 and into vented screws 434. The remainder ofthe cables are end effector cables, collectively designated at 360, thatgo by the idling pulleys 500, 502, 504, 506. In an alternate embodiment,the vented screws 434 in the tension adjustment systems 432 may bereplaced by any externally threaded object that can connect to thecontrol cables 240 a, 240 b, 240 c, 240 d that enables adjustment viathe method described above for the end effector control cables 360 inthe manipulator 102. The idling pulleys 500, 502, 504, 506 pivot aboutpins 516 such that adjustments can be made in the relative positioningof the proximal and distal universal joints 104, 108.

FIGS. 44 and 45 show external views of the universal joint statictension assemblies 410, 412. Tension adjustment systems 432 provideanchoring and adjustment for the universal joint control cables 240 a,240 b, 240 c, 240 d in the same manner as the tightening and adjustmentof the end effector cables 360 described above.

FIGS. 46, 47, and 48 show the active tensioning assemblies 420, 422,spring 424, and spacer 426 for the end effector control cables 360. Theactive tensioning assemblies 420, 422 each include two plates 520, 522mounted on two pins 524, 526, 528, 530 each of which holds a pair oftensioning pulleys 532, 534, 536, 538.

The tensioning pulleys 532, 534, 536, 538 in these assemblies 420, 422contain bearings 540 as shown in FIG. 48, and are connected to the baseplates 406, 408 via the bearings 540. FIG. 48 shows the tensioningassemblies 420, 422 with plates 522 removed. The bearings 540 in thesetensioning pulleys 532, 534, 536, 538 allow them to freely rotate as thecontrol cables 360 move to transmit motion from the manipulator 102 tothe end effector 110.

The cables 360 b, 360 d that control the proximal phalanxes 154, 156pass under one pair of tensioning pulleys 532, over another pair oftensioning pulleys 534, and continue to a guide pulley 428. Thistensioning assembly 420 can rotate on a pin 524 via a bearing 540mounted in one of the base assembly plates 408. When the tensioningassembly 420 rotates counterclockwise, moving the second pair of tensionpulleys 534 upward, the tension in cables 360 b and 360 d increases.

The cables 360 a, 360 c that control the distal phalanxes 158, 160 passover one pair of tensioning pulleys 536, under another pair oftensioning pulleys 538, and continue to the guide pulley 428. Thistensioning assembly 422 can rotate on a pin 528 via a hearing 540mounted in one of the base assembly plates 406. When the tensioningassembly 422 rotates clockwise, moving the second pair of tensionpulleys 538 downward, the tension in cables 360 a and 360 c increases.

The rotary spring 424, mounted on the spacer 426, applies a force toboth tensioning assemblies 420, 422 via pins 526, 530 in each assembly420, 422. This causes the tensioning assemblies 420, 422 to move apartand increase the tension in the end effector control cables 360. Themotion of the universal joints 104, 108 can add or subtract tension inthe end effector control cables 360, but as long as the cables 360 b,360 d that control the proximal phalanxes 154, 156 maintain equaltension and the cables 360 a, 360 c that control the distal phalanxes158, 160 maintain equal tension, then there will be no effect on thepositioning of the end effector 110 due to motion of the universaljoints 104, 108.

An alternate embodiment could include, instead of a rotary spring, alinear compression spring, linear extension spring, or flexible elementacting as a spring to create the force driving the tensioning assemblies420, 422 apart, or separate spring mechanisms.

FIG. 49 shows the details of the cabling system that drives the proximalphalanxes 154, 156 of the end effector 110. After passing around a guidepulley 428, cables 360 b and 360 d are wrapped around a drive pulley 550mounted on a pin 552 and enter vented screws 432 as previously discussedwith respect to FIG. 39, which allows the position of the firstphalanxes 154, 156 to be calibrated relative to the position of thethumb assembly 142 and primary index assembly 144 during manufacturing.

After passing around a guide pulley 428, cables 360 a and 360 c continuearound an idler pulley 464 toward the secondary index assembly 146. Aspreviously discussed, the primary index assembly 144 and thumb assembly142 are coupled by a set of gears 450, 452. This allows force applied tothe primary index assembly 144 to be transferred to the thumb assembly142 to indirectly drive the cables 360 b, 360 d that control theproximal phalanxes 154, 156 with the thumb assembly 142.

FIG. 50 shows the details of the cabling system within the manipulator102 that controls the distal phalanxes 158, 160. After passing around anidler pulley 440, cables 360 a and 360 c continue to a driving pin 554in base 468 of the secondary index assembly 142 alter which theyterminate in tension adjustment systems 432, as previously discussed,which may be done to calibrate the position of the secondary indexassembly 146 relative to the distal phalanxes 158, 160 duringmanufacturing. Cable 360 c passes around a guide pin 556 in order to bealigned with its tensioning screw 434.

If the user rotates the primary index assembly 144 and thumb assembly142 relative to the base assembly 140 without rotating the secondaryindex assembly 146 relative to the primary index assembly 144, then thecables 360 a, 360 c that control the distal phalanxes 158, 160 willtranslate by the same linear distance as the cables 360 b, 360 d thatcontrol the proximal phalanxes 154, 156. This will result in no netmotion of the controlling links 310, 312 in the end effector 110relative to the proximal phalanxes 154, 156, and subsequently no netmotion of the distal phalanxes 158, 160 relative to the proximalphalanxes 154, 156, thus imitating the motion of the manipulator 102. Ifthe user rotates the secondary index assembly 146 relative to theprimary index assembly 144 without moving the primary index assembly 144and thumb assembly 142 relative to the base assembly 140, the cables 360a, 360 c that control the distal phalanxes 158, 160 will translate whilethe cables 360 b, 360 d that control the proximal phalanxes 154, 156will remain stationary. This will only result in motion of the distalphalanxes 158, 160 relative to the proximal phalanxes 154, 156, thuscopying the motion of the user's index finger to both digits 150, 152 ofthe end effector 110.

The surgical instrument described herein may provide an end effectorthat may be articulated within the body of a patient about three axes ofrotation relative to the cannula containing the instrument during use.The distal universal joint 108 provides two degrees of freedom, and athird degree of freedom arises from the instrument being rotatablewithin the cannula through which it is inserted. When the manipulator isrotated about its longitudinal axis, it forces a rotation of the tubesection 106 within the cannula and a corresponding longitudinal rotationof the end effector, and the end effector 110 can be articulated withthe three degrees of freedom, which correspond to yaw, pitch, and roll.The roll motion (rotation about the longitudinal axis) may be producedby rotating the instrument 100 as a whole, as opposed to conventionaldesigns where an end effector is designed to rotate about itslongitudinal axis independent of the rest of the instrument.

Although only a few exemplary embodiments have been shown and describedin considerable detail herein, it should be understood by those skilledin the art that it is not intended to be limited to such embodimentssince various modifications, omissions and additions may be made to thedisclosed embodiments without materially departing from the novelteachings and advantages, particularly in light of the foregoingteachings. For example, although a manipulator with thumb and indexfinger actuation is shown, and an end effector with two digits each withtwo phalanxes are shown, the novel assembly shown and described hereinmay be used other types of manipulators and end effectors. Accordingly,we intend to cover all such modifications, omission, additions andequivalents as may be included within the spirit and scope as defined bythe following claims. In the claims, means-plus-function clauses areintended to cover the structures described herein as performing therecited function and not only structural equivalents but also equivalentstructures. Thus, although a nail and a screw may not be structuralequivalents in that a nail employs a cylindrical surface to securewooden parts together, whereas a screw employs a helical surface, in theenvironment of fastening wooden parts, a nail and a screw may beequivalent structures.

What is claimed is:
 1. A surgical tool for use by an operator,comprising: a manipulator adapted to receive at least a portion of theoperator's hand; a proximal universal joint having a first end and asecond end, the proximal universal joint first end being mounted to themanipulator; a hollow elongated member having a first end, a second end,and a longitudinal axis, the elongated member first end being mounted tothe proximal universal joint second end; a distal universal joint havinga first end and a second end, the distal universal joint first end beingmounted to the elongated member second end; and an end effector mountedto the distal universal joint second end.
 2. The surgical tool of claim1, wherein pivoting of the first end of the proximal universal jointcauses the second end of the distal universal joint to move in acorresponding motion.
 3. The surgical tool of claim 1, furthercomprising cabling operatively coupling the proximal and distaluniversal joints, wherein the proximal and distal universal joints eachinclude a proximal yoke at the first end, a distal yoke at the secondend, a center block, and means for pivoting the center member about twoperpendicular, coplanar axes through the center block, wherein theproximal yoke is mounted to the center block at first and secondmounting locations, the distal yoke is mounted to the center block atthird and fourth mounting locations, and between the center block andeach yoke at each mounting location are round elements, which may beindependent parts or integral to either of the center block or yokes,wherein the cabling comprises four cables that each engage two of theround elements at each of the proximal and distal universal joints, andwherein pivoting the proximal yoke on the proximal universal jointcauses a corresponding motion of the distal yoke of the distal universaljoint.
 4. The surgical tool of claim 1, wherein the end effectorcomprises a base member and two opposed digits, each digit with aproximal phalange having a first end and a second end, the proximalphalange first end pivotally mounted to the base member, and a distalphalange having a first end and a second, free end, the first endpivotally mounted to the proximal phalange second end.
 5. The surgicaltool of claim 4, wherein the manipulator comprises a first actuatoroperable to concurrently control the proximal phalanxes and a secondactuator operable to concurrently control the distal phalanxes.
 6. Thesurgical tool of claim 5, wherein the second actuator is mounted to theend of at least a part of the first actuator.
 7. The surgical tool ofclaim 6, wherein the first actuator comprises a first lever assemblyadapted to be operable with the operator's thumb, wherein actuating thefirst lever assembly causes the proximal phalanges to move relative toeach other.
 8. The surgical tool of claim 7, wherein the first actuatorfurther comprises a second lever assembly adapted to be operable with afinger of the same hand of the operator as the thumb, and whereinadvancing the first and second lever assemblies toward each other causesthe proximal phalanges to move toward each other.
 9. The surgical toolof claim 8, wherein the second actuator comprises a third lever assemblypivotally mounted to the second lever assembly.
 10. The surgical tool ofclaim 9, wherein each lever assembly has a longitudinal axis, and whenthe longitudinal axis of the third lever assembly is pivoted away fromthe longitudinal axis of the second lever assembly, the distal phalangesmove toward each other.
 11. The surgical tool of claim 10, wherein theend effector is control by four end effector control cables, and whereintwo cables control the proximal phalanxes and two cables control thedistal phalanges.
 12. The surgical tool of claim 11, wherein the twocables that control the proximal phalanxes are operatively connected tothe first lever assembly.
 13. The surgical tool of claim 11, wherein thetwo cables that control the distal phalanxes are operatively connectedto the third lever assembly.
 14. The surgical tool of claim 11, whereinthe end effector control cables are tensioned with resiliently biasedpulleys included in the manipulator.
 15. The surgical tool of claim 11,wherein the proximal and distal universal joints each comprise aproximal and distal end member, with each end member including a baseportion and opposing arms extending from the base portion, the proximalend member and the distal end member mounted to a center block for eachjoint, the center block pivotable around two substantially coplanar,perpendicular axes, wherein the base portions and center block defineopenings for receiving the end effector control cables.
 16. The surgicaltool of claim 1, wherein the proximal and distal universal joints arecontrolled by universal joint control cables, and the end effector iscontrolled by end effector control cables, and the universal jointcontrol cables and the end effector control cables are anchored in themanipulator and may be adjusted with means for tensioning the universaljoint control cables and the end effector control.
 17. An articulationsystem for a surgical tool, comprising: a proximal universal jointincluding a proximal end member and a distal end member; a hollowelongated member having a first end, a second end, and a longitudinalaxis, the elongated member first end being mounted to the proximaluniversal joint distal end member; a distal universal joint comprising aproximal end member and a distal end member, the distal universal jointproximal end member being mounted to the elongated member second end;and universal joint control cables operatively connecting the proximaland distal universal joints; wherein pivoting motion of the proximal endmember of the proximal universal joint relative to the longitudinal axisof the elongated member exerts force on cables to cause a correspondingpivoting motion of the distal end member of the distal universal joint.18. The surgical tool of claim 17, wherein each end member of theproximal universal joint and the distal universal joint includes a baseportion and opposing arms extending from the base portion, wherein eachrespective proximal end member and distal end member are mounted to acenter member at the arms of the proximal end member and the distal endmember, and wherein the center members permit pivoting of the proximaland distal end members around two substantially coplanar, perpendicularaxes through the center member.
 19. The surgical tool of claim 18,wherein the proximal universal joint and the distal universal joint eachinclude round elements interposed between the center member and the armsat the mounting locations of the end members to the center member, andwhich may be independent parts or integral to the center member or arms,and wherein the round elements are engaged by the universal jointcontrol cables.
 20. A surgical tool for use by an operator, comprising:a manipulator adapted to receive at least a portion of the operator'shand, the manipulator including a mounting end, a first actuator, and asecond actuator; a hollow elongated member having a first end, a secondend, and a longitudinal axis, the elongated member first end operativelyconnected to the mounting end of the manipulator; and an end effectorincluding a mounting end, the mounting end operatively connected to theelongated member second end, wherein the end effector includes a basemember and two opposed digits, each digit with a proximal phalange and adistal phalange, the proximal phalange having a first end and a secondend, the proximal phalange first end pivotally mounted to the basemember, and the distal phalange having a first end and a second, freeend, the first end pivotally mounted to the proximal phalange secondend, wherein the first actuator is operable to concurrently control theproximal phalanxes and the second actuator is operable to concurrentlycontrol the distal phalanxes.